Individual
DR. RICARDO R GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D
Contact information
Practice address
168 AVE. DE SAN MARCOS, GLORIETA, NM 87535
(505) 757-2216
Mailing address
P.O BOX 375, GLORIETA, NM 87535
(505) 757-2216
(505) 465-1155
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
3779
NM
103TC0700X
Clinical Psychologist
Primary
414
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
N1903
—
NM
05
—
N6708
—
NM
05
—
N6708/N1903
—
NM
Enumeration date
12/22/2005
Last updated
01/14/2014
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